resources Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 1-877-532-3778, elpasohealth.com. Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP11502507 - EPH-PR-Fall 2025 Provider Newsletter 2025 © Coffey Communications, Inc. All rights reserved. Avoid claim denials and reimbursement delays Submitting a clean claim the first time is one of the most effective ways to reduce administrative delays and ensure timely reimbursement. At El Paso Health, we are committed to supporting our Provider network with tools and education that promote successful claims processing. Below are some of the most common reasons for claim denials—and actionable tips to help your practice avoid them: 1. Missing or incomplete documentation What we’re seeing: Lack of medical records to support services billed, especially for high-cost procedures or durable medical equipment (DME). Tip: Always include supporting documentation with the initial claim when required (e.g., invoices for DME, notes for prolonged services, or justification for nonroutine care). 2. Inaccurate or incomplete coding What we’re seeing: Invalid CPT / HCPCS codes, incorrect modifiers, or mismatch between diagnosis and procedure. Tip: Stay current with annual code updates. Use the appropriate modifier to prevent bundling or rebundling issues. Confirm that diagnosis codes align with the services rendered. 3. Untimely filing What we’re seeing: Claims submitted beyond the allowable filing window. Tip: Monitor your internal timelines closely. Ensure that claims are submitted within the contracted time frame to avoid automatic denials. 4. Place of service (POS) mismatch What we’re seeing: Discrepancies between the POS listed on the claim and the Provider’s credentialed setting. Tip: Ensure that POS codes accurately reflect the location of service delivery and align with Provider enrollment records. 5. Lack of authorization or incorrect details What we’re seeing: Claims missing a required prior authorization or billing outside of authorized dates or services. Tip: Confirm that an approved authorization is on file before rendering services and ensure that claim details (CPT, units, dates) match the authorization exactly. Best practices for clean claim submissions ■Double-check member eligibility before service. ■Use clearinghouse edits and internal scrubbing tools to flag errors before submission. ■Regularly audit denied claims to identify trends or training opportunities for your billing team. ■Include itemized invoices when billing for equipment or high-cost drugs / biologics. Special services for children of traveling farmworkers El Paso Health has special Medicaid services for the children of traveling farmworkers. The services include assistance with scheduling their upcoming Texas Health Steps exams as well as vision, mental health, and transportation benefits for them. If you have any questions or would like to receive more information about these services for children of traveling farmworkers or would like for the program coordinator to provide an in-service to your staff, please call the Outreach Coordinator at 915-532‑3778, ext. 1075.
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